TsUTsUGAMUShI (tsutsugamushi; synonym: kedan fever, shrubby typhus, typhus of the jungle, tropical tick-borne typhus, the Japanese river fever) — infectious be-lezn, caused by rickettsiae of a tsu-tsugamusha, to-rye are transferred to the person by larvae of krasnotelkovy mites; it is characterized by existence of primary affect on skin, the general lymphadenopathy and makulopapulez-ache rash.
The disease is for the first time described in Japan in 1810 by Hashimo-to, to-ry suggested to call its tsutsugamush that is meant by a tick-borne disease. In 1905 Hayasi (N. Naua-shi) opened a disease-producing factor, and in 1923 carried it to the sort Rickettsia (see Rickettsiae) with a specific name of R. tsutsugamushi. The complete description of the activator under the name R. orientalis is made by Nagayo (M. Nagayo) in 1930 and N. Ogata in 1931. The new stage of studying of a disease is connected with high incidence in the American and English troops in Southeast Asia in the years of World War II. In 1947 — 1948 E. N. Pavlovsky suggested about existence of a tsutsugamusha in Sovetsk Primorye that in 1963 was confirmed with S. M. Kulagin's researches, G. P. Somova, etc. Then in the USSR R. tsutsugamushi was allocated from krasnotelkovy mites (see) and from small wild mammals in the southern districts of Primorsky Krai. Fixators to rickettsiae of this look were found in nek-ry persons, and also the first cases are registered.
Tsutsugamusha is registered in Japan, on islands of the Malay Archipelago, in the countries of Southeast Asia, in Northern Australia, in the mountain districts of India. In our country of C. it is revealed in a number of districts of Primorsky Krai, in Bikin district of Khabarovsk Krai, on the islands of Peter the Great Bay, in the southern part of Sakhalin and on the island Shikotan.
E theology. The infestant represents a polymorphic microorganism (diploba-
to a tsnll) 0,3 — 1,5 microns long and 0,2 — 0,5 microns wide. Breeds only in protoplasm of cells. Distinguish three main serotypes of the activator: Gilliam (it is allocated in Burma in 1944), Karp (it is allocated on New Guinea in 1949), Kato (it is allocated in Japan, causes heavy disease). Besides, allocate a number of strains of Seerangayee, Imphal, Calcutta, Kastival, No. 9, No. 21,
No. 22. The strains allocated in Primorsky Krai of the USSR are identified as the serotype of Gilliam which is characterized by small pathogenicity for the person.
Epidemiology. C. — a natural and focal disease (see. Natural ochagovost). Source of an infection are mouse-like rodents, ascigerous and insectivorous; disease carriers — larvae of krasnotelkovy mites of the sorts Lep-totrombidium and Neotrombicula from this. Trombiculidae, to-rye attack people and animals for a krovoso-saniye. At the same time the ticks which are at the stages of development following a larva (nymphs and puberal individuals) are not bloodsuckers. «Having received» a disease-producing factor with blood of an animal, the larva cannot transfer him to an animal or the person at once; the activator is transferred only transstadiyno — at first to nymphs, and from them — to adult mites. The last transovarialno transfer the activator to new generation of larvae (see. Transovarial transfer), and only the new generation of the larvae which hatched from the eggs laid by the infected females in a year is capable to transfer the activator to people or animals. Infection of people is connected with stay in the territory of the local centers (see the Endemia), for to-rykh the shrubby and grassy thickets occupied by krasnotelkovy mites are characteristic. Incidence among people is registered preferential in the period of the greatest activity of larvae of krasnotelkovy mites, i.e. in July — September.
Pathogeny. The rickettsiae which got into a human body at a sting of the infected larvae of mites get into cells of an endothelium of vessels in the place of implementation and in regional limf. nodes. As a result of it primary affect (see Affect primary) and regional lymphadenitis develops (see). Then rickettsiae get into circulatory system, breed in cells of an endothelium of vessels where small knots — granulomas are formed (see). After that again there is a mass exit of rickettsiae in blood, the generalized polyadenitis and the phenomena of intoxication develop (see). With a blood flow the activator is brought in fabrics and parenchymatous bodies, at the same time development of inflammatory changes of various degree of manifestation in a pericardium, a pleura, a peritoneum with formation of exudate in them is possible (see the Polyserositis).
Pathological anatomist and I. Reveal the changes characteristic of intersticial pneumonia (see), diffusion intersticial myocarditis (see), toxic dystrophy of a liver (see), an acute splenitis (see the Spleen) with the phenomena of an episplenitis (see). Acute focal or diffusion intersticial nephrite (see) without considerable defeats of renal balls, in this regard a renal failure is noted at C. clinically it is not shown. The expressed changes in serous cavities with availability of whitish-yellowish exudate are observed (see). Increase and puffiness regional limf, nodes, existence in them inflammatory infiltrativ-nykh changes and a generalized lymphadenopathy are characteristic. On face skin, trunks and extremities petekhialny rash (see Petechias), and also primary affect, sometimes on a gn a willow yushchiysya is observed.
Also mmunitt after a disease low-resistant and short; repeated cases are celebrated.
Clinical picture. An incubation interval (see) 7 — 18, 8 — 12 days are more often. Primary affect arising almost at once after a sting of a larva is painless; it is found only at attentive inspection of the patient and represents inflame l no-in-
the filtrativny center on skin to dia. 0,2 — 1,5 cm. Primary affect disappears in 3 — 4 weeks after falling away of the crust which is formed in the center of the necrotic site; the naked crateriform sore is quickly epithelized, coloring of skin is normalized. Almost along with primary affect regional lymphadenitis without suppuration (fig.), at the same time limf develops, nodes are not soldered to skin. The disease begins suddenly, the feeling of heat and the expressed fever or chilling, the general weakness and weakness, a headache, pains in eye-sockets, in a waist, in extremities, including in joints appears. The loss of appetite, thirst are noted, the vomiting, diarrhea and moderate abdominal pains, apparently, connected with increase mesenteric limf, nodes are possible. Language is laid often over by a white or dirty-gray plaque.
In the first 2 — 3 days of a disease constant or remittiruyushchy body temperature (see) reaches 40 — 41 °, the headache, nara-
Riye amplifies. Back surface of a neck of the patient of a tsutsugamusha: 1 — primary affect; 2 — regional lymphadenitis [on JIe to Le Gae with sotr., 1959].,
will melt weakness, considerable perspiration is characteristic, there is sleeplessness, sick eyforichna, are easily excitable and irritable. Often they are disturbed by dry cough and pharyngalgias. The dermahemia of the person and neck, an injection of vessels of scleras, nek-paradise puffiness a century and easy puffiness of the person, a hyperemia of a mucous membrane of a soft palate and a uvula, an early enantema are noted (see Rashes). Bradycardia (see), quite often a dicrotism of pulse (see), hypotension, muting of cardiac sounds with expansion in hard cases of its borders are observed. At an electrocardiographic research decrease in a voltage and flattening of a tooth of comes to light that demonstrates development of intersticial myocarditis. On 3 — the 4th day of a disease at many patients is observed increase in a liver and spleen. On 4 — the 7th day of a disease almost at all patients appears rash, rozeolez-ny in the beginning, then rozeolezno-papular, it extends to all body parts and disappears in 2 — 3 days at dominance of roseolas and in 5 — 6 days at dominance of papules. The generalized lymph the denopatiya caused by hematogenous dissimination of rickettsiae develops. On
5 — the 8th day of a disease can appear block and a struporous state (see) with a delirium (see. Delirious syndrome). The general tremor, muscular twitchings and even the isolated spasms of extremities is observed.
Changes from a respiratory organs of a malokharakterna, only in hard cases the specific intersticial pneumonia revealed only at rentgenol develops. research.
Usually in 2 — 3 weeks body temperature is normalized and only sometimes within 3 — 5 days its repeated increase probably owing to allergization of an organism is noted.
Complications are usually connected with accession of consecutive infection and preferential damage of lungs; sepsis (see), thrombophlebitis (see), decubituses (see), parotitis is possible (see).
The diagnosis is made on the basis of data of the epidemiological anamnesis (stay in places of distribution of krasnotelkovy mites in the period of activity of their larvae) also by a wedge, pictures. Results of reaction of binding complement (at the same time use of antigens of strains of several serotypes) and Veyl's reactions — Felix (see Veyl — Felix reaction is desirable) with use of a diagnosticum from a protea of UCC confirm the diagnosis.
Differential diagnosis is carried out with an epidemic sapropyra (see the Sapropyra epidemic), the North about an Asian tick-borne
rickettsiosis (see), a flea rickettsiosis (see. Flea typhus local;), acute infectious eritema (see the Erythema), a medicinal allergy (see), a dengue (see).
Treatment. Appoint parenteral administration of antibiotics of group of tetracycline or levomycetinum in average therapeutic doses during 6 — 7 and sometimes 10 days. According to indications apply pathogenetic and symptomatic means.
Forecast. The lethality reached before 20 — 46% and more. From the beginning of use of antibiotics of deaths it is almost not observed.
Prevention consists in protection of the person against attack of larvae of krasnotelkovy mites, and also in their destruction. For protection against attack of larvae of mites use protective overalls with hoods and impregnate clothes repellents (see). At expansion of an expedition in habitals of larvae of krasnotelkovy mites the platform for tents is cleared of a bush, the grass is burned out or removed together with the turf, the iochva is processed contact acaricides (see).
See also Rickettsioses.
Bibliography: 3 d r about p about in with to and y P. F. both about l and N e in and the p E. M. The doctrine about rickettsiae and rickettsioses, page 318, M., 1972; K. M Mullet. The most important rickettsioses of the person, page 271, L., 1980; Podolyan V. Ya. Sketches of medical geography of Japan. M, 1966: Prirodnoochagovy diseases in Primorsky Krai, under the editorship of G. P. Somov and G.V. Kolonin, page 102,
Vladivostok, 1975; The Guide to infectious diseases, under the editorship of V. I. Pokrovsky and K. M. Loban, page 182, M., 1 977; G. P. som, etc. Fever of a tsutsu-gamusa on the Kuril Islands, Zhurn. mikr., epid. and immun., N ° 2, page 69, 1976; A. S's Allen. Spitz S. A. Comparative study of pathology of scrub typhus (tsutsugamushi disease) of and other rickettsial diseases, Amer. J. Path., v. 21, p. 603, 1945; Settle E. B., Pinkerton H. Corbett A. J. Pathologic study of tsutsugamushi disease (scrub typhus) of with notes on clinicopathologic correlation, J. Lab. clin. Med., v. 30, p. 639, 1945. K. M. Loban.